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CT-guided percutaneous biopsy of intrathoracic lesions.

Lal H, Neyaz Z, Nath A, Borah S - Korean J Radiol (2012)

Bottom Line: Percutaneous CT-guided needle biopsy of mediastinal and pulmonary lesions is a minimally invasive approach for obtaining tissue for histopathological examination.Although it is a widely accepted procedure with relatively few complications, precise planning and detailed knowledge of various aspects of the biopsy procedure is mandatory to avert complications.In this pictorial review, we reviewed important anatomical approaches, technical aspects of the procedure, and its associated complications.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

ABSTRACT
Percutaneous CT-guided needle biopsy of mediastinal and pulmonary lesions is a minimally invasive approach for obtaining tissue for histopathological examination. Although it is a widely accepted procedure with relatively few complications, precise planning and detailed knowledge of various aspects of the biopsy procedure is mandatory to avert complications. In this pictorial review, we reviewed important anatomical approaches, technical aspects of the procedure, and its associated complications.

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Related in: MedlinePlus

Axial CT image of 18-year-old male that showed multiple mediastinal nodes. Biopsy was obtained from left parasternal approach lateral to internal thoracic artery (arrowhead) as lymph nodal mass was touching chest wall sufficiently to allow safe access lateral to internal thoracic vessels. To maintain needle in proper alignment wet gauze piece was placed (arrow). Biopsy results suggested Hodgkin lymphoma.
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Figure 18: Axial CT image of 18-year-old male that showed multiple mediastinal nodes. Biopsy was obtained from left parasternal approach lateral to internal thoracic artery (arrowhead) as lymph nodal mass was touching chest wall sufficiently to allow safe access lateral to internal thoracic vessels. To maintain needle in proper alignment wet gauze piece was placed (arrow). Biopsy results suggested Hodgkin lymphoma.

Mentions: The parasternal approach is used for the biopsy of anterior and middle mediastinal lesions when the lesion can be targeted from the lateral margin of the sternum (5). In this approach, the needle was inserted directly into the target lesion or through the intervening fat. The patient is usually placed in the supine position; however, sometimes the lateral decubitus position may be helpful for creating a safe window. The internal thoracic vessels should always be identified as they are located lateral to sternal margin and inadvertent injury may result in hematoma formation. In most cases, a needle is inserted close to the lateral margin of the sternum and medial to these vessels (Fig. 17). Sometimes, needle could be inserted lateral to the internal thoracic vessels if the lesion or the mediastinal fat was touching the anterior chest wall sufficiently lateral to the vessels (Fig. 18). Moreover, the degree of contact between the mediastinum and the parasternal chest wall may vary with breathing during the biopsy procedure, resulting in the inadvertent transgression of the pleura or lung (Fig. 19).


CT-guided percutaneous biopsy of intrathoracic lesions.

Lal H, Neyaz Z, Nath A, Borah S - Korean J Radiol (2012)

Axial CT image of 18-year-old male that showed multiple mediastinal nodes. Biopsy was obtained from left parasternal approach lateral to internal thoracic artery (arrowhead) as lymph nodal mass was touching chest wall sufficiently to allow safe access lateral to internal thoracic vessels. To maintain needle in proper alignment wet gauze piece was placed (arrow). Biopsy results suggested Hodgkin lymphoma.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3303905&req=5

Figure 18: Axial CT image of 18-year-old male that showed multiple mediastinal nodes. Biopsy was obtained from left parasternal approach lateral to internal thoracic artery (arrowhead) as lymph nodal mass was touching chest wall sufficiently to allow safe access lateral to internal thoracic vessels. To maintain needle in proper alignment wet gauze piece was placed (arrow). Biopsy results suggested Hodgkin lymphoma.
Mentions: The parasternal approach is used for the biopsy of anterior and middle mediastinal lesions when the lesion can be targeted from the lateral margin of the sternum (5). In this approach, the needle was inserted directly into the target lesion or through the intervening fat. The patient is usually placed in the supine position; however, sometimes the lateral decubitus position may be helpful for creating a safe window. The internal thoracic vessels should always be identified as they are located lateral to sternal margin and inadvertent injury may result in hematoma formation. In most cases, a needle is inserted close to the lateral margin of the sternum and medial to these vessels (Fig. 17). Sometimes, needle could be inserted lateral to the internal thoracic vessels if the lesion or the mediastinal fat was touching the anterior chest wall sufficiently lateral to the vessels (Fig. 18). Moreover, the degree of contact between the mediastinum and the parasternal chest wall may vary with breathing during the biopsy procedure, resulting in the inadvertent transgression of the pleura or lung (Fig. 19).

Bottom Line: Percutaneous CT-guided needle biopsy of mediastinal and pulmonary lesions is a minimally invasive approach for obtaining tissue for histopathological examination.Although it is a widely accepted procedure with relatively few complications, precise planning and detailed knowledge of various aspects of the biopsy procedure is mandatory to avert complications.In this pictorial review, we reviewed important anatomical approaches, technical aspects of the procedure, and its associated complications.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

ABSTRACT
Percutaneous CT-guided needle biopsy of mediastinal and pulmonary lesions is a minimally invasive approach for obtaining tissue for histopathological examination. Although it is a widely accepted procedure with relatively few complications, precise planning and detailed knowledge of various aspects of the biopsy procedure is mandatory to avert complications. In this pictorial review, we reviewed important anatomical approaches, technical aspects of the procedure, and its associated complications.

Show MeSH
Related in: MedlinePlus